Sleep apnea linked to silent strokes
February 1st, 2012
09:00 AM ET

Sleep apnea linked to silent strokes

Lisa Shives, M.D., is the founder of Northshore Sleep Medicine in Evanston, Illinois. She blogs regularly on The Chart. Read more from her at Dr. Lisa Shives’ Sleep Better Blog.

This week, a study was presented at the American Stroke Association’s International Stroke Conference that caught my eye.  It's a small study that adds further evidence to what most sleep experts already know - that obstructive sleep apnea (OSA) is linked with a high risk of having silent strokes.

OSA is the most common form of sleep apnea, according to the National Institutes of Health.  More than 12 million Americans are believed to suffer from this sleep disorder. People with sleep apnea stop breathing for 10 to 20 seconds or longer and this can happen at least 20 to 30 times an hour. 

In this new study, researchers at Dresden University in Germany, looked at silent strokes and the prevalence of OSA in 56 patients who had been hospitalized for a major stroke.

What’s the difference between a major stroke and a silent stroke?  Silent strokes are usually only detected by imaging the brain with an MRI and/or CT scan which can show areas of damage even though the person was not aware of an obvious neurological deficit at the time of the scarring.

Silent strokes have been linked to an increase risk for a major stroke. Therefore, if we can establish and then eliminate risk factors for silent stroke, theoretically, we can prevent major strokes that kill and disable.

The stroke victims in the study were broken into two groups: Those who had evidence of silent strokes and those who did not.  They also looked at those who had evidence of chronic damage to the small blood vessels in the brain and those who did not.  They wanted to see if OSA was more prevalent in those with silent stroke and chronic vascular damage.

Ninety-one percent of the study’s patients had obstructive sleep apnea, identified by an overnight sleep test.  This is an extremely high prevalence rate for OSA if we consider that the rate for general population of middle age and older adults is 20 to 25%.

Unfortunately, this high prevalence rate makes it difficult for researchers to study the question that most interests them: Is OSA a predictor and possibly contributing cause of silent stroke?

Almost everyone in the study had OSA, whether they had evidence of silent stroke or not, so it's hard to say that OSA is an independent predictor of silent stroke.  OSA is not only a risk factor for major stroke, but can be a consequence of stroke. Therefore, we cannot assume that OSA preceded the major stroke or the silent strokes.

All limitations aside, this study looks at important questions. Obstructive sleep apnea is still an under-diagnosed disorder, and given the strong association with stroke, it behooves researchers to uncover any links between the two.

Here’s some more on sleep apnea:

OSA is defined as a collapse of the upper airway that occurs when the tissues in the throat relax with sleep.   When the soft tissue in the back of the throat is relaxed, it can block the flow of air.  This leads to a drop in oxygen, a rise in carbon dioxide, an increase in adrenalin, an increase in blood pressure and an increase in arousals from sleep that can be so brief that the patient is unaware of them.

OSA is significant if it occurs more than 5 times per hour and is associated with daytime sleepiness, cognitive dysfunction, hypertension, and cardiovascular disease.

Even in the absence of associated symptoms or diseases, if you stop breathing more and 15 times per hour, it's considered unhealthy and treatment is recommended.  Moderate-to-severe OSA increases the risk not just of stroke, but also heart disease, high blood pressure, diabetes and obesity.

Those who are overweight or have a small throat are at greatest risk.  Men are twice as likely as women to have OSA, but after menopause that gender difference disappears and women are just as likely to have it.  This could be one of the reasons why many women who had no previous trouble with sleep find that during and after menopause, their sleep is plagued with frequent awakenings.

It is important to keep in mind that children and teenagers can have OSA too, often due to enlarged tonsils and can be misdiagnosed with behavioral, learning and psychiatric disorders when the root of the problem is actually something as easy to diagnose and treat as sleep apnea.

The good news is that one overnight sleep study, whether in a sleep center or at home, can easily detect apnea. There are several effective types of treatment including continuous positive airway pressure (CPAP), mandibular advancing devices and Provent, a new therapy that can stent the airways using non-mechanical airflow resistance.

soundoff (917 Responses)
  1. Maserati Quattroporte Q4

    There is definately a lot to learn about this topic. I really like all the points you've made.


    May 19, 2021 at 05:59 | Report abuse | Reply
  2. JebgEncox

    Singulair http://pharmacylo.com/ buy online prescription drugs

    May 19, 2021 at 08:26 | Report abuse | Reply
  3. forex robots

    739623 938816Great V I should definitely pronounce, impressed with your website. I had no trouble navigating through all tabs and related info ended up being truly easy to do to access. I recently found what I hoped for before you know it at all. 138834

    May 19, 2021 at 13:58 | Report abuse | Reply
  4. RV Remodel Riverside

    You've made some decent points there. I checked on the internet for more info about the issue and found most individuals will go along with your views on this site.


    May 19, 2021 at 16:01 | Report abuse | Reply
  5. JebgEncox

    Prozac http://pharmacylo.com/ canadian pharmacies that ship to us

    May 19, 2021 at 16:14 | Report abuse | Reply
  6. AnooEncox

    third female lawmaker introduces bill to limit men's viagra access https://llviagra.com/ – wo kann man billig viagra kaufen salg av viagra i norge

    May 19, 2021 at 18:13 | Report abuse | Reply
  7. tv repair in temecula


    May 19, 2021 at 19:45 | Report abuse | Reply
  8. Digital Marketing Company Near Me


    May 20, 2021 at 00:32 | Report abuse | Reply
  9. RebfZisse

    cialis genetic http://rcialisgl.com/ buy cialis without prescription

    May 20, 2021 at 04:13 | Report abuse | Reply
  10. RebfZisse

    cialis generic cambodia http://rcialisgl.com/ daily cialis reviews

    May 20, 2021 at 06:26 | Report abuse | Reply
  11. Video Marketing Agency


    May 20, 2021 at 09:01 | Report abuse | Reply
  12. Digital Marketing Agency

    Hello there, I believe your blog might be having browser compatibility issues. Whenever I take a look at your web site in Safari, it looks fine however when opening in Internet Explorer, it has some overlapping issues. I just wanted to provide you with a quick heads up! Other than that, excellent site!


    May 20, 2021 at 09:38 | Report abuse | Reply
  13. Local Marketing Agency

    Spot on with this write-up, I really think this amazing site needs a great deal more attention. I’ll probably be returning to read through more, thanks for the info!


    May 20, 2021 at 11:12 | Report abuse | Reply
  14. GtnbCrulk

    walgreen viagra https://jokviagra.com/ viagra discount

    May 20, 2021 at 13:14 | Report abuse | Reply
  15. SEO Marketing Companies


    May 20, 2021 at 14:58 | Report abuse | Reply
  16. Mercedes Sprinter Service Locations

    I was able to find good information from your content.


    May 20, 2021 at 15:19 | Report abuse | Reply
  17. RV Repair California

    Everything is very open with a precise clarification of the challenges. It was really informative. Your website is useful. Many thanks for sharing!


    May 20, 2021 at 20:30 | Report abuse | Reply
  18. red tube photo

    I couldn’t resist commenting. Very well written!


    May 20, 2021 at 21:25 | Report abuse | Reply
  19. LbsoZisse

    cheap viagra and cialis in australia https://ucialisdas.com/ buy cialis black

    May 20, 2021 at 22:32 | Report abuse | Reply
  20. rv parts san diego


    May 20, 2021 at 23:01 | Report abuse | Reply
  21. RV Dashboard Orange County

    I like reading an article that can make people think. Also, thanks for permitting me to comment!


    May 21, 2021 at 01:38 | Report abuse | Reply
  22. LbsoZisse

    buy cialis online overnight shipping https://ucialisdas.com/ – cialis 36 hour online cialis

    May 21, 2021 at 02:32 | Report abuse | Reply
  23. RV Blinds California

    It’s difficult to find experienced people about this subject, but you seem like you know what you’re talking about! Thanks


    May 21, 2021 at 02:50 | Report abuse | Reply
  24. BbshMile

    average age of man taking viagra http://loxviagra.com/ – viagra online without prescription viagra pictures

    May 21, 2021 at 05:20 | Report abuse | Reply
  25. rv slide out roof repair


    May 21, 2021 at 05:52 | Report abuse | Reply
  26. FmrfEncox

    gum cialis http://cialisee.com/ purchase cheap cialis

    May 21, 2021 at 07:41 | Report abuse | Reply
  27. LebnEncox

    canada pharmacy online no script http://xlnpharmacy.com/ northwest pharmacy/com

    May 21, 2021 at 08:24 | Report abuse | Reply
  28. RV Paint Shop Los Angeles

    I seriously love your blog.. Great colors & theme. Did you build this site yourself? Please reply back as I’m trying to create my own website and want to find out where you got this from or just what the theme is called. Thank you!


    May 21, 2021 at 11:25 | Report abuse | Reply
  29. tires orange county

    Way cool! Some very valid points! I appreciate you penning this article and the rest of the website is really good.


    May 21, 2021 at 13:17 | Report abuse | Reply
  30. Internet Marketing Firm

    Greetings! Very helpful advice within this post! It's the little changes that will make the most important changes. Thanks a lot for sharing!


    May 21, 2021 at 13:58 | Report abuse | Reply
  31. RV Upholstery Riverside

    I’m amazed, I must say. Seldom do I come across a blog that’s equally educative and interesting, and let me tell you, you've hit the nail on the head. The issue is something that not enough men and women are speaking intelligently about. I'm very happy that I found this in my hunt for something regarding this.


    May 21, 2021 at 14:30 | Report abuse | Reply
  32. Local Marketing Firm

    This web site truly has all the information and facts I needed concerning this subject and didn’t know who to ask.


    May 21, 2021 at 14:33 | Report abuse | Reply
  33. Video Marketing Agencies


    May 21, 2021 at 16:51 | Report abuse | Reply
  34. rv repair near my location

    I could not refrain from commenting. Exceptionally well written!


    May 21, 2021 at 23:12 | Report abuse | Reply
  35. Digital Marketing Companies

    Having read this I thought it was extremely enlightening. I appreciate you spending some time and effort to put this informative article together. I once again find myself spending way too much time both reading and posting comments. But so what, it was still worthwhile!


    May 22, 2021 at 00:26 | Report abuse | Reply
  36. custom rv paint


    May 22, 2021 at 02:12 | Report abuse | Reply
  37. Content Marketing Agencies


    May 22, 2021 at 03:52 | Report abuse | Reply
  38. Local Marketing Company

    Great web site you've got here.. It’s hard to find excellent writing like yours nowadays. I truly appreciate people like you! Take care!!


    May 22, 2021 at 05:13 | Report abuse | Reply
  39. national interstate rv insurance reviews


    May 22, 2021 at 07:54 | Report abuse | Reply
  40. windshield replacement lake forest

    Hi! I could have sworn I’ve been to this web site before but after going through a few of the articles I realized it’s new to me. Nonetheless, I’m definitely delighted I stumbled upon it and I’ll be bookmarking it and checking back frequently!


    May 22, 2021 at 09:44 | Report abuse | Reply
  41. Digital Marketing Specialist

    Aw, this was an exceptionally nice post. Spending some time and actual effort to make a superb article… but what can I say… I procrastinate a whole lot and don't manage to get anything done.


    May 22, 2021 at 10:24 | Report abuse | Reply
  42. RV Center Los Angeles

    I love it when individuals come together and share opinions. Great website, continue the good work!


    May 22, 2021 at 10:55 | Report abuse | Reply
  43. truck shop orange county

    Spot on with this write-up, I honestly believe this amazing site needs a lot more attention. I’ll probably be returning to see more, thanks for the information!


    May 22, 2021 at 11:59 | Report abuse | Reply
  44. travel trailer frame repair


    May 22, 2021 at 19:08 | Report abuse | Reply
  45. LebnEncox

    canadian family pharmacy order medicine online which pharmacy is cheaper

    May 22, 2021 at 19:41 | Report abuse | Reply
  46. RV Windows Los Angeles

    Your style is very unique in comparison to other folks I have read stuff from. Many thanks for posting when you've got the opportunity, Guess I'll just bookmark this web site.


    May 22, 2021 at 19:45 | Report abuse | Reply
  47. remodeled rvs interior

    I’m amazed, I must say. Rarely do I encounter a blog that’s both equally educative and entertaining, and without a doubt, you've hit the nail on the head. The issue is something too few people are speaking intelligently about. Now i'm very happy I found this during my search for something regarding this.


    May 23, 2021 at 03:28 | Report abuse | Reply
  48. RV Tires California

    Everything is very open with a really clear clarification of the challenges. It was definitely informative. Your website is extremely helpful. Many thanks for sharing!


    May 23, 2021 at 05:04 | Report abuse | Reply
  49. AnooEncox

    viagra para doença pulmonar https://llviagra.com/ do not take viagra with

    May 23, 2021 at 05:29 | Report abuse | Reply
  50. SEO Marketing Consultants

    Hello there! I just want to give you a big thumbs up for the great information you have got here on this post. I am coming back to your blog for more soon.


    May 23, 2021 at 10:56 | Report abuse | Reply
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

Leave a Reply to KbcxMile


CNN welcomes a lively and courteous discussion as long as you follow the Rules of Conduct set forth in our Terms of Service. Comments are not pre-screened before they post. You agree that anything you post may be used, along with your name and profile picture, in accordance with our Privacy Policy and the license you have granted pursuant to our Terms of Service.

About this blog

Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.